"Yes, the jet lag is different now, and she celebrated my birthday early last night. Yang Wei said.

“......”

All right.

Since you think it's good, Ruan Bin doesn't bother to say more.

Say that phrase no matter how you like it, as long as you like it.

The next day.

The First Affiliated Hospital of Modu.

Interventional Section.

Consultation room.

Jia Yanguan, Koji Kimura, Kojiro Miyamoto and several others are consulting a patient with a very severe chronic total occlusion (CTO) of a coronary artery.

The patient is a 63-year-old male with coronary heart disease and severe coronary artery occlusion. Previously, Jia Yanguan and others had conducted a full set of examinations for the patient, and the results showed that the proximal right coronary artery was diffuse stenosis, 100% occlusion after the first turn, the anterior blood flow TIMI0 grade, the left anterior descending coronary artery was completely occluded, and the right coronary artery main artery was completely occlusive!

"Professor Kimura, do you think this patient can be operated on?" Jia Yanguan looked at Koji Kimura and asked with a hint of expectation.

Koji Kimura and Kojiro Miyamoto were both sent by the Asian CTO Club to their interventional department for academic exchange and study, as well as to participate in their interventional surgery.

Because there are a lot of CTO patients in their interventional department, these two islanders are also rushing to this point.

This Koji Kimura is a well-known doctor in the CTO world, with superb surgery, and has developed several improved versions of CTO interventional surgery, which enjoys a good reputation in the industry!

Jia Yanguan also saw from the past few days that the other party was indeed a skilled doctor, and he had done a total of 8 surgeries in the past few days, all of which were successful!

There are even a few patients who can be discharged the next day after surgery.

At the same time, he also learned a lot of advanced CTO approach techniques, and he felt that the other party was indeed worthy of the title of "great country craftsman" of the island country.

"TIMI0? It's too serious!" Koji Kimura said with a frown furrowed and a stiff Chinese accent.

In coronary angiography surgery, surgeons often grade the patient's coronary blood flow, which is called TIMI grading, which mainly includes 4 grades: Grade 0: refers to no perfusion, indicating vascular occlusion, and no anterior blood flow at the distal end!

It is also the most serious situation! It shows that the complete occlusion of coronary blood vessels is very serious!

"Diffuse stenosis of the proximal right coronary artery, 100% occlusion after the first turn, occlusion of the lesion site up to 25mm!Left anterior descending coronary artery complete occlusion, occlusion of more than 28mm, complete occlusion of the right coronary artery artery and occlusion of more than 20mm......!

The three places completely occluded the lesions, the most serious cases of the typical coronary heart disease three-way occlusion, and the most important thing is that the occlusion lesion site is too long, which is 25, 28, and 20mm!

This rare length of contempt amazed him, he had never met a patient in an occluded position for thirty years!

One is that there are few patients in his island country, after all, the total population is small, and the patient base must be small.

The second is a population of more than one billion people in China, so the patient base is large, and it is easy to encounter such rare cases!

This is also the reason why he brought his apprentice to the First Affiliated Hospital of Modu to learn and communicate, and participate in surgery to help improve the other party's skills.

He will be able to have the opportunity to perform surgeries on more patients, so as to accumulate cases and experience, and he can also improve his surgical skills, so as to develop a better and more advanced new CTO interventional surgery!

Seeing Koji Kimura's shocked expression, Jia Yanguan's heart sank slightly, and he also felt tricky in the eyes of this professor, it seems that this operation is not easy to do.

In fact, when he first started to examine the patient, he was almost frightened when he saw such a serious condition, so serious, he would have a myocardial infarction at any time!

He thought that he couldn't succeed in the operation, so just now Koji Kimura had just finished an operation, and he quickly pulled the other party to the consultation room for a consultation!

The other party's level is definitely several times higher than him!

But now seeing the other party's expression, can't the other party do it?

"It's very difficult, and I've only encountered it in some literature, so let me think about the surgical approach and opening problem. Koji Kimura began to think.

"Reverse interventional CTO techniques mainly include snouting guidewire technology, reverse guidewire passage technology, controlled forward and reverse subintimal pathfinding technology, etc. For short lesions (15~20 mm) or the anatomy is unknown, the Contemporary Reverse CART or Knuckle technique is preferred. When the reverse wire passing technique or the wire-to-wire kissing technique fails, you should switch to the Reverse CART technique as soon as possible......," Koji Kimura began to mutter.

"No, no, this conventional forward and reverse approach can't be done, the lesion is too long, the longest is 28mm...... Gotta think of a better way!"

The longer the completely occluded calcified lesion, the longer the guidewire passes through the CTO lesion, the guidewire will often encounter insufficient support and the balloon cannot pass through, and if it is replaced with the highest hardness guidewire, it will also easily cause puncture of the blood vessel into the dissection.

So the longer the lesion, the more difficult the surgery!

After thinking about it for about half an hour, Koji Kimura's eyes suddenly lit up: "Yes, you can try using the balloon anchoring technique in combination with the Guidezilla catheter." The lateral branches of the spacer branch can be dilated with small balloon at low pressure (1.0~1.25 mm @ 2~4 atm), and the Threader catheter can be used reasonably!"

"Master, you are really amazing! You can come up with a feasible surgical plan for such a serious patient!"

"Haha...... This is all thanks to my extensive surgical experience, and you can work hard in the future. Koji Kimura enjoyed the sycophancy.

"That's great, that's great! But there's one tricky thing I forgot to tell Professor Kimura about you. Jia Yanguan saw that Koji Kimura was able to come up with a feasible surgical plan, and I have to say that it is really strong!

"What's the problem?" asked Koji Kimura lightly.

What are the other tricky questions?

Could it be panda blood?

Afraid of heavy bleeding during surgery?

I won't bleed if I do it myself!

"When the patient underwent a coronary angiography examination, he found that he was allergic to contrast agents, not the most serious, but moderate! I wonder if you can have zero contrast surgery?" Jia Yanguan said.

"Nani?" Hearing this, Koji Kimura was stunned.

Allergic to contrast media?

Although it is moderate, it may cause headache, dizziness, nausea and vomiting, hives, facial flushing, eyelids and lips redness, runny nose, sneezing, tearing, chest tightness and shortness of breath.

This condition is absolutely contraindicated for surgery!

Not to mention...... What if it gets worse during the operation?

At that time, it is estimated that the patient will die on the operating table before the direct operation is completed!

"You can't risk surgery, Jasan, give up on this operation. Koji Kimura shook his head in stiff Chinese.

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